25 July 2011

Wow, it's been a long time since I updated. Definitely a record for me. So, what's been going on?
To start, my wife had her mastectomies at the beginning of June. The whole month was occupied with taking care of her and the kids while also trying to work enough to pay the mortgage (the bank can be quite unreasonable in their insistence on this point). We had family in-home for an entire month -- more, I think. All went well with the surgery and the healing process, though it was perhaps harder than we all expected. Now Liza is onto radiotherapy and doing OK. Her hair is growing back, she is getting her energy back (slowly) and feeling more like herself again. Feel free to stop by her blog and offer some support.

Somewhere in there we opened a new ER. It went very smoothly, as befitting the enormous amount of work that went into the planning for the transition. The volumes have been up just a bit, but it's been very strange. We are averaging 285 patients a day, up about 5%, but the variability has been huge. We will see 240 patients one day and 330 the next. Bizarre, and impossible to predict and staff for. We never had that sort of wild oscillations in the old place. Hopefully it will either settle out or become predictable over time. The operations part of moving in went very well indeed, and working in the new place is an unadulterated pleasure. There are some nursing kinks (the new greet/triage process is a bit hinky) but they are pretty minor. The time metrics have gotten absurdly low: 7 minutes from door to bed, on average, and 28 minutes from door to doc. Fewer than 1% leave without being seen. Patients seem really happy, and the staff is happier and less stressed than I can recall ever seeing. I can't wait to see our patient satisfaction scores when they start coming back.

Which is not to say things are perfect. We see to be having more late-day volume than we expected and may have to make some tweaks to the schedule. There is most definitely room for improvement. But overall, I'm enjoying going to work more than I ever have in the past. The only real problem is that the place is SO HUGE. if you have errands on different sides of the department the travel time is not inconsiderable. I should get a pedometer to see how far I am walking in a shift. I was thinking of getting those "heelie" shoes with hidden wheels, but one of my partners did me one better and tore his achilles tendon, so he got himself one of the kneeling wheel-carts. I get jealous watching him skate through the department at high speed on that thing. Wish I could tear my achilles tendon...

We've finished our hiring for the year, we think (and hope), and the new folks are starting to come on board, which is always really gratifying. I'm always incredibly impressed by the quality of people we are able to attract and it's very satisfying watching them step out into an independent role for the first time ever and watching them grow and their careers progress.

I'm getting old -- I'm up for my first board recertification this fall. So I have to study for that. The test is too damn expensive to show up and take it cold (don't think I wasn't tempted.)

Personally, the kids are off school and the house is crazy. They never stop moving, and are just exhausting to watch. My sister was out here to help and took to calling them the "noise beasts." We had one nice vacation to Crater Lake and through central/southern Oregon, and we will be hitting Lake Crescent in another couple of weeks. The baby is crawling all over the place, and getting ready to walk.
I hope to update a few more times in upcoming days -- I have a large number of posts kicking around in my head. Whether I have the time to sit down and put them into words is another question. For the moment, I will put up this picture of the baby, who REALLY likes herself some chocolate chip pancakes, and I will belatedly update the masthead to reflect the fact that I now have four children.

Shadowfax

About me: I am an ER physician and administrator living in the Pacific Northwest. I live with my wife and four kids. Various other interests include Shorin-ryu karate, general aviation, Irish music, Apple computers, and progressive politics. My kids do their best to ensure that I have little time to pursue these hobbies.

Disclaimer

This blog is for general discussion, education, entertainment and amusement. Nothing written here constitutes medical advice nor are any hypothetical cases discussed intended to be construed as medical advice. Please do not contact me with specific medical questions or concerns. All clinical cases on this blog are presented for educational or general interest purposes and every attempt has been made to ensure that patient confidentiality and HIPAA are respected. All cases are fictionalized, either in part or in whole, depending on how much I needed to embellish to make it a good story to protect patient privacy.

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